| John K. Russell, Ph.d. A Psychological Corporation | |
|
1945 Palo Verde Avenue Suite 202 Long Beach CA 90815-3445 | |
| (562) 799-3333 | |
| (562) 799-3355 |
| Full Name | John K. Russell, Ph.d. A Psychological Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 1945 Palo Verde Avenue, Long Beach, California |
| Authorized Official Name and Position | John Kenneth Russell (PRESIDENT) |
| Authorized Official Contact | 5627993333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John K. Russell, Ph.d. A Psychological Corporation 1945 Palo Verde Ave Suite 202 Long Beach CA 90815-3443 Ph: (562) 799-3333 | John K. Russell, Ph.d. A Psychological Corporation 1945 Palo Verde Avenue Suite 202 Long Beach CA 90815-3445 Ph: (562) 799-3333 |
| NPI Number | 1851711881 |
|---|---|
| Provider Enumeration Date | 04/17/2014 |
| Last Update Date | 04/17/2014 |
| Medicare PECOS PAC ID | 9032335336 |
|---|---|
| Medicare Enrollment ID | O20140723000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851711881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | PSY4430 (California) | Primary |
| Provider Name | John K Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407843295 PECOS PAC ID: 3476776501 Enrollment ID: I20140519001083 |
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